More Exercise = More Plaque
Physionic
Apr 13, 2026
Episode description
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References
[Study 699] Pauwels R, Dausin C, Ruiz-Carmona S, De Bosscher R, De Paepe J, Bekhuis Y, et al. Wearable-derived training load and coronary atherosclerosis in middle-aged and older athletes and physically active controls: a new perspective from the Master@Heart Study. Circulation. Published online January 29, 2026. doi:10.1161/CIRCULATIONAHA.125.077117.
Funding/Conflict: Public Funding: From the study, the Master@Heart study was supported by a research grant from the Research Foundation Flanders (FWO Vlaanderen), grant T003717N; Rik Willems was supported as a post-doctoral clinical researcher by FWO Vlaanderen; and Jarne De Paepe and Youri Bekhuis were also supported by FWO Vlaanderen, with file numbers 1189325N and T004420N, respectively; Non-Profit Funding: From the study, no non-profit funding was reported; Industry Funding: From the study, no industry funding was reported; Conflicts of Interest: From the study, disclosures were none.
[Study 703] De Bosscher R, Dausin C, Claus P, et al. Lifelong endurance exercise and its relation with coronary atherosclerosis. Eur Heart J. 2023;44(26):2388-2399. doi:10.1093/eurheartj/ehad152.
Funding/Conflict: Public Funding: From the study, the Master@Heart study was funded by the Fund for Scientific Research, Flanders (T003717N); Non-Profit Funding: From the study, no non-profit funding was reported; Industry Funding: From the study, no industry funding was reported; Conflicts of Interest: From the study, all authors declared no conflict of interest for this contribution.
[Study 704] Ramakrishnan R, Doherty A, Smith-Byrne K, Rahimi K, Bennett D, Woodward M, et al. Accelerometer measured physical activity and the incidence of cardiovascular disease: evidence from the UK Biobank cohort study. PLoS Med. 2021;18(1):e1003487. doi:10.1371/journal.pmed.1003487.
Funding/Conflict: Public Funding: From the study, support was reported from the National Institute for Health Research Oxford Biomedical Research Centre, the Alan Turing Institute, the British Heart Foundation, Health Data Research UK, the Medical Research Council Industrial Strategy Studentship (MR/S502509/1), the Oxford Martin School, and the UK Research and Innovation Global Challenge Research Fund (ES/P011055/1) ; Non-Profit Funding: From the study, no non-profit funding was reported ; Industry Funding: From the study, no industry funding was reported ; Conflicts of Interest: From the study, Kazem Rahimi reported past personal fees as Associate Editor for PLOS Medicine and personal fees from BMJ Heart, Mark Woodward reported being a consultant to Amen and Kirin, and Rosemary Walmsley was supported by a Medical Research Council Industrial Strategy Studentship; the Medical Research Council had no role in the study design, data collection, analysis, interpretation, writing, or submission decision.
0:00 - Introduction
0:27 - Prepare to be Shocked
1:50 - Duration vs Intensity: Just One of the Problem
2:53 - More Plaque, Less Heart Disease?
4:14 - Dissent in the Literature
5:25 - 4 Factors to Consider
8:07 - An Alarming Result
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Mindsip insights from this episode:
Reassess lifelong exercise impact on arterial plaque accumulation
Shockingly, individuals who have exercised their entire lives were found to have more arterial plaque than those who started exercising later in life.
Recognize risks of dangerous plaque in long-term exercisers
Long-term exercisers not only have more plaque but also more of the dangerous mixed and non-calcified types, which are more likely to rupture.
Prioritize resistance training to avoid arterial plaque risks
The concerning findings about increased arterial plaque from long-duration exercise do not apply to resistance training.
Reassess high-volume exercise due to increased artery blockage risk
A concerning finding was that high-volume exercisers had a higher prevalence of arteries with over 50% blockage (stenosis).
Limit high-volume exercise to reduce plaque risk
The high-volume exercise group linked to increased plaque averaged around 10 hours of endurance exercise per week, such as marathon or triathlon training.
Prioritize duration over intensity for arterial health
The increase in arterial plaque is linked specifically to the duration of exercise, not the intensity of the exercise alone.
Engage in light endurance exercise for heart health
Light endurance exercise for up to three hours per week is considered low-risk and likely beneficial for long-term heart health.
Understand plaque mortality paradox in active individuals
Although very physically active people show more calcified plaque, studies do not find this translates to an increased risk of cardiovascular death.
Utilize wearables to uncover exercise and plaque connection
The connection between exercise and plaque was only found using objective data from wearable devices, as less accurate self-reported data did not show the same relationship.
Reassess plaque risks in lifelong endurance athletes
A 2023 study on lifelong endurance athletes found they did not have a less risky, more stable form of plaque compared to healthy non-athletes, removing a previously believed 'silver lining'.
Maintain high-volume exercise to counteract arterial plaque risks
Despite having more arterial plaque, high-volume exercisers in a 17-year study were not more likely to die from heart disease or other causes.
Utilize wearables to uncover risks of high-intensity training
The strong link between high-intensity training and plaque was only visible using wearable monitors; the association vanished when using traditional self-reported data.
Combine high volume and intensity for optimal exercise benefits
High-intensity exercise alone was not linked to high plaque levels, but high volume combined with large amounts of high-intensity training showed the strongest connection.
Implement aggressive cholesterol-lowering strategy for optimal health
One speaker aims to keep his LDL cholesterol below 50-60 mg/dL using medications like Pravastatin and Ezetimibe, even at age 34 with no other risk factors.
Limit intense exercise to reduce arterial plaque risk
The most heavily trained athletes were found to be almost six times more likely to have plaque developing in their arteries than those who trained the least.
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